Take The First Step

To help our patients understand our center

Patient Medical History (blue Health History)

Your answers on this form will help your health care provider get an accurate history of your medical concerns and conditions. If you are a current patient there is a shorter update form you can use.
Patient MEDICAL History (blue form pg 1)
Patient DENTAL History (blue form pg 2)

Patient Information (purple Registration)

Please take the time to fill out our New Patient Questionnaire prior to your appointment. In order to maintain confidentiality and respect your privacy- we ask that you bring this signed completed form to your first appointment .
Patient Information (Purple form)
Patient Information (Purple form-Interactive)

Emergency Dental Registration and Treatment (white)

Your answers on this form will help your health care provider get an accurate history of your medical concerns and conditions. If you are a current patient there is a shorter update form you can use.
Emergency Dental Registration and Treatment

Directions & Map to Grieco Dentistry

Please take the time to fill out our New Patient Questionnaire prior to your appointment. In order to maintain confidentiality and respect your privacy- we ask that you bring this signed completed form to your first appointment. Click here directions.

Financial Agreement

Patients are expected to pay for our services at the time they are rendered. Our patients who have dental insurance are expected to pay the amount of their estimated co-pay & deductible at the time of service. A complete discussion regarding financial options including terms & conditions will be held during your consultation with Dr. Grieco.

HIPPA – Notice of Patient Privacy

The Office for Civil Rights enforces the HIPAA Privacy Rule, which protects the privacy of individually identifiable health information; the HIPAA Security Rule, which sets national standards for the security of electronic protected health information.

Insurance Information

Most insurance companies offer a variety of benefit plans with different features. You may have co-workers or friends who are also covered by Delta Dental, but their coverage may differ from yours.

Transfer of Dentist Form

Your patient chart contains mainly clinical information, providing your new practitioner an objective viewpoint about your dental health. While dental records are incredibly detailed, they usually don't contain your payment history or your dentist's personal opinions of you.

Dr. Derek Grieco, DMD

Grieco Dentistry is a professional dental practice devoted to restoring and enhancing the natural beauty of your smile using natural biological, conservative, state-of-the-art procedures/materials that will result in a beautiful smile! We are one of the few offices in the Pittsburgh area trained to remove silver mercury fillings safely. Please inquire more about our technique with biological dentistry.